By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

While exercise is widely advocated for patients with hypertension and heart disease, the type of exercise that is usually recommended is aerobic or dynamic exercise. Now (February 2000) the American College of Sports Medicine and the American Heart Association have issued a joint statement regarding the benefits of resistance exercise (weight training). They recommend that resistance exercise can be used in combination with aerobic exercise.

The relative benefits of the two types are summarized in the table below:

Factor	Aerobic Exercise	Resistance Exercise
Muscle strength	No change	Increase
Endurance	Increase	Slight increase
Max. O2 consumption	Increase	Little change
Basal metabolism	Slight increase	Increase
Lean body mass	No change	Increase
Body fat	Decrease	Slight decrease
Systolic pressure	Slight decrease	No change
Diastolic pressure	Slight decrease	Slight decrease
Heart rate	Decrease	No change
LDL cholesterol	Slight decrease	Slight decrease
HDL cholesterol	Slight increase	Slight increase
Bone density	Increase	Increase
Insulin sensitivity	Increase	Increase

Resistance training strengthens the muscles that are being trained, and also builds muscle mass. The increased muscle mass raises the basal metabolism, which means more calories are burned. However, aerobic exercise is superior as a means of losing weight.

Both types of exercise are good for preventing osteoporosis.

Aerobic exercise is better for reducing blood pressure, although resistance training may lower diastolic pressure a little. Aerobic exercise lowers the resting heart rate, while resistance exercise has no effect. There is a big increase of both systolic and diastolic pressure during resistance exercise; however, this increase is less when the muscle is trained.

Both types of exercise produce a slight improvement in the blood lipid profile, with a reduction of LDL and an increase of HDL cholesterol. Another beneficial affect is an improvement in insulin sensitivity. Low insulin sensitivity (otherwise known as insulin resistance) is one of the causes of adult onset diabetes.

The report states that resistance training is safe in people with mild hypertension (160/100 mmHg or less), but cautions against it if the pressure is higher than this. The recommendation is to do 8 to 10 repetitions of a variety of exercises, which include chest press, shoulder press, triceps extension, biceps curl, leg curls, etc. The exercises should be performed two or three times week for about 30 minutes in total at each session.

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